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Journal ArticleDOI

Family planning methods among women in a vaginal microbicide feasibility study in rural KwaZulu-Natal, South Africa

01 Aug 2008-African Journal of Reproductive Health (Women's Health and Action Research Center)-Vol. 12, Iss: 2, pp 45-63
TL;DR: Age, marital status, education level and parity were associated with different contraceptive method choices, and contraceptive use increased significantly among women followed longitudinally for 9 months, largely due to increased condom use.
Abstract: This study investigated contraceptive use among women in rural KwaZulu-Natal, South Africa. Of 866 sexually active women not intending pregnancy and screened for a microbicide feasibility study, 466 (54%) reported currently using modern contraceptives: injectables (31%), condoms (12%), sterilization (6%) and pills (4%). Multivariable logistic regression analyses revealed statistically significantly higher odds of current contraceptive use among married vs. engaged/unmarried women (aOR 1.64), multiparous vs. nulliparous (aOR 4.45) and women who completed secondary education or above vs. primary or less (aOR 1.64). Significantly lower odds of use were observed among women aged 40+ vs. age 15-19 (aOR 0.38). Age, marital status, education level and parity were associated with different contraceptive method choices. Among 195 women followed longitudinally for 9 months, contraceptive use increased significantly from 56% to 70%, largely due to increased condom use (15% to 28%). Results highlight the importance of integrating family planning and HIV/STI prevention counseling and informing promotion of further contraceptive uptake among women not intending pregnancy. (Afr J Reprod Health 2008; 12[2]:45-63) RESUME

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Journal ArticleDOI
TL;DR: Pooling of data from 14,874 women in an individual participant data meta-analysis by Nicola Low and colleagues reveals that some intravaginal practices increase the risk of HIV acquisition.
Abstract: Background: Identifying modifiable factors that increase women’s vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition. Methods and Findings: We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I 2 values 0.0%– 16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18–1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00–1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01–1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04–1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p,0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p,0.001), respectively. Conclusions: This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated. Please see later in the article for the Editors’ Summary. Citation: Low N, Chersich MF, Schmidlin K, Egger M, Francis SC, et al. (2011) Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual

247 citations


Cites background from "Family planning methods among women..."

  • ...9; South Africa [41] FPC, immunisation clinics Women attending clinics 12 mo 3 Monthly 07/03–07/04 261 29....

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  • ...For example, McClelland and colleagues found a strong association between intravaginal cleaning with soap and incident HIV infection in Kenya [8] but van de Wijgert and colleagues and Myer and colleagues found no associations in their studies in Uganda and Zimbabwe [44] and South Africa [20]....

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  • ...Inserting products to dry or tighten the vagina was uncommon; this was most commonly reported in four studies conducted in South Africa and Zimbabwe, where the prevalence was 13%–20% (studies 1 Zimbabwe, 7 Zimbabwe, and 8 South Africa)....

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  • ...Studies done in South Africa tended to have a low overall prevalence of any current vaginal practice (18%–27%, studies 8–10) and studies in Zimbabwe tended to have a high prevalence (69%–92%, studies 1, 6, 7)....

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  • ...Cleaning with water, with or without other practices, was reported by more than 60% of women in all but four studies in South Africa (studies 7 South Africa, 8–10)....

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Journal ArticleDOI
26 Aug 2013-PLOS ONE
TL;DR: A significant gap exists between future FP intentions and current FP practices, and integration of individual and couple FP services into routine HIV care, treatment and support services is needed in order to avoid unintended pregnancies and to prevent mother-to-child HIV transmission.
Abstract: Background: Preventing unintended pregnancies among HIV-positive women through family planning (FP) reduces pregnancy-related morbidity and mortality, decreases the number of pediatric HIV infections, and has also proven to be a cost-effective way to prevent mother-to-child HIV transmission. A key element of a comprehensive HIV prevention agenda, aimed at avoiding unintended pregnancies, is recognizing the attitudes towards FP among HIV-positive women and their spouse or partner. In this study, we analyze FP attitudes among HIV-infected pregnant women enrolled in a PMTCT clinical trial in Western Kenya. Methods and Findings: Baseline data were collected on 522 HIV-positive pregnant women using structured questionnaires. Associations between demographic variables and the future intention to use FP were examined using Fisher’s exact tests and permutation tests. Most participants (87%) indicated that they intended to use FP. However, only 8% indicated condoms as a preferred FP method, and 59% of current pregnancies were unintended. Factors associated with positive intentions to use FP were: marital status (p=0.04), having talked to their spouse or partner about FP (p,0.001), perceived spouse or partner approval of FP (p,0.001), previous use of a FP method (p=0.006), attitude toward the current pregnancy (p=0.02), disclosure of a sexually transmitted infection (STI) diagnosis (p=0.03) and ethnic group (p=0.03). Conclusion: A significant gap exists between future FP intentions and current FP practices. Support and approval by the spouse or partner are key elements of FP intentions. Counseling services should be offered to both members of a couple to increase FP use, especially given the high number of unplanned pregnancies among HIV-positive women. Condoms should be promoted as part of a dual use method for HIV and STI prevention and for contraception. Integration of individual and couple FP services into routine HIV care, treatment and support services is needed in order to avoid unintended pregnancies and to prevent mother-to-child HIV transmission.

51 citations

Journal ArticleDOI
TL;DR: It is indicated that improving education, providing employment opportunities for women, and providing training to family planning providers are essential to increasing contraceptive use.
Abstract: Family planning has improved the well-being of families by preventing high-risk pregnancies and abortions and reducing unplanned pregnancies. However, the effectiveness of family planning efforts has not been consistent across countries. This study examined factors associated with contraceptive use among married women in Ethiopia. Data were from the 2011 Ethiopian Demographic and Health Survey. The sample comprised 10,204 married women (aged 15-49 years). Logistic regression models were used to analyze the data. Among married women in Ethiopia, 29.2% used contraceptive methods. About 44.1% of women who were not current users of contraceptives reported that they intended to use contraceptives in the future. Age at first marriage, being educated, number of living children, exposure to mass media, being employed, having educated partners, and having been informed about contraceptive use at health facilities were positively associated with current contraceptive use. By contrast, older age, a rural resident, or Muslim; belonging to the Afar or Somali ethnic groups; desiring numerous children; having husbands who desired additional children; and abortion experience were negatively associated with current contraceptive use. Our findings indicated that improving education, providing employment opportunities for women, and providing training to family planning providers are essential to increasing contraceptive use.

46 citations


Cites background from "Family planning methods among women..."

  • ...Theoretical framework of contraceptive service use. employment status of women was also positively related to contraceptive use (Subramanian et al. 2009)....

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  • ...employment status of women was also positively related to contraceptive use (Subramanian et al. 2009)....

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Journal ArticleDOI
TL;DR: In this article, the authors investigated patterns, levels and socio-demographic determinants of condom use and consistency of use among young adults aged 15-24 years in rural KwaZulu- Natal.
Abstract: Aim: To investigate patterns, levels and socio-demographic determinants of condom use and consistency of use among young adults aged 15-24 years. Background: Condoms are known to prevent HIV infection. However, HIV prevalence and incidence remain high. Methods: This study was conducted in the Africa Centre Demographic Surveillance Area (ACDSA) in rural KwaZulu- Natal. Analysis focused on resident young adults aged 15-24 years in 2005. In univariable and multivariable analyses, determinants of condom use and consistency of use among 15-24 year olds were estimated using data collected in 2005. 'Ever' condom use was defined as the proportion who reported having used a condom; consistent use among those ever using as "always" using condoms with most recent partner in the last year. Results: 3,914 participants aged 15-24 years reported ever having sex, of whom 52% reported condom use. Adjusting for age, sex, number of partners, residence of partner, partner age difference, type of partner and socio-economic status (SES), having an older partner decreased likelihood (aOR=0.69, p<0.01), while belonging to a household in a higher SES increased likelihood of ever using condoms (aOR=1.82, p<0.01). Being female (aOR=0.61 p<0.01) and having a regular partner (aOR=0.65 p<0.01) were independently associated with low consistent condom use. Conclusions: In this rural South African setting, condom use remains low, especially among females and with an older partner, situations commonly associated with increased HIV acquisition. Targeted supportive interventions to increase condom use need to be developed if HIV prevention programmes are to be successful.

43 citations

References
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Journal ArticleDOI
TL;DR: Factors which were significantly associated with utilisation of contraception were availability of family planning services, parity, knowledge of contraception and child spacing, and Religion, literacy level, attitudes offamily planning providers and distance to family planning Services were not found to be significant.
Abstract: This study investigates the prevalence and determinants of contraceptive practice in Ile-Ife, Nigeria. A prospective study of 500 rural women in the reproductive age group was conducted between April to June 1999 in the Igboya health district of Ife central local government area of Osun State. A comprehensive contraceptive promotion and distribution had been carried out in this area by the University Teaching Hospital, the State Ministry of Health and many non-governmental organisations in the past 10 years. It is therefore expected that the contraceptive awareness and use in this environment would be high. Unfortunately, although all the respondents (100%) were aware of contraception and 78% were sexually active, only 18.8% used contraception. A majority of the non-users gave no reasons for failure to use contraception. Among reasons given by others include fear of side effects, no need for contraception, not married, religion, need for more children and student status. The most common contraceptive method among users was intrauterine contraceptive device followed by pills, condoms and injectable contraceptives. Factors which were significantly associated with utilisation of contraception were availability of family planning services, parity, knowledge of contraception and child spacing (P 0.05). Recommendations that will improve wide contraceptive usage are preferred.

72 citations

Journal ArticleDOI
TL;DR: Prevention programs could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection and by promoting condoms for protection against these dual risks.
Abstract: High levels of HIV/AIDS and unwanted pregnancy among young people are urgent public health problems in South Africa. Studies among youth have generally focused on protection against one or the other of these risks but not both. Data collected in 2001 from 2067 sexually active men and women aged 15--24 in KwaZulu-Natal were examined in bivariate and multivariate analyses to assess reasons for condom use and levels and determinants of use. Overall 59% of respondents said that they used condoms at last sexual intercourse including 6% who used them with another method. The main reason for use (cited by 64% of users) was protection against both pregnancy and HIV infection. Two-thirds of respondents thought that becoming or making someone pregnant in the next few weeks would be a big problem; fewer than one in five viewed their risk of HIV infection as medium or high. Among both sexes young people who would consider a pregnancy highly problematic were more likely to use condoms than their counterparts who would view a pregnancy as no problem (odds ratios 1.4--2.3). In sharp contrast young men and women who perceived themselves as having a medium to high risk of HIV infection were less likely to use condoms than their counterparts who perceived themselves as being at no risk (0.2--0.3). Prevention programs could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection and by promoting condoms for protection against these dual risks. (authors)

71 citations

Journal ArticleDOI
TL;DR: Self-perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects, and condoms use was particularly high among individuals reporting multiple sexual partners or extramarital relationships.
Abstract: A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15-49 declined significantly from 15 percent to 13 percent. Women practicing family planning for pregnancy prevention were predominantly in the 20-39-year age group, married, better educated, and had higher parity than others, whereas women or men adopting condoms were predominantly young, unmarried, and better educated. Condom use was particularly high among individuals reporting multiple sexual partners or extramarital relationships. Contraceptive use was higher among women who desired fewer children, among those who wished to space or terminate childbearing, and among women with previous experience of unwanted births or abortions. Self-perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects. Contraception for pregnancy prevention and for HIV/STD prophylaxis are complementary.

67 citations

Journal ArticleDOI
TL;DR: Age-group-specific logistic regression models show that despite strong state family planning programs targeting black women, these women were less likely than nonblacks to practice modern contraception both before and after the political transition, even after controlling for large racial-group differences in sociodemographic characteristics and the distribution of socioeconomic resources.
Abstract: In 1994, South Africa underwent a transition from the institutionalized racism of an apartheid state to a nonracial democracy. This study uses data from two surveys conducted in the style of the Demographic and Health Surveys to compare patterns and predictors of racial differences in modern contraceptive use in the late- and post-apartheid periods. Age-group-specific logistic regression models show that despite strong state family planning programs targeting black women, these women were less likely than nonblacks to practice modern contraception both before and after the political transition, even after controlling for large racial-group differences in sociodemographic characteristics and the distribution of socioeconomic resources. Black, colored, Indian, and white women show different patterns of contraceptive use across their reproductive careers; in particular, young, unmarried black and colored women show high levels of use. Use of injectable contraceptives is also high among black and colored women, whereas injectables are not the primary method used by Indian or white women. These findings are discussed in light of their research and policy implications.

63 citations

Journal ArticleDOI
TL;DR: Results show that variation in contraceptive use across homeland areas diminished with the addition of community controls for development and migration, and indicated that localized conditions could offset the advantages or disadvantages of living in a former homeland.
Abstract: In this paper, patterns of contraceptive use among black South African women in the late 1980s are examined. Multilevel logit models are used to evaluate the extent to which segregation of the African population into homelands gave rise to uneven patterns of contraceptive use; how this pattern was shaped by variations in family-planning acceptability; and the way in which the system of male labor migration and social and economic inequities across communities affected women's use of contraceptives. Results show that variation in contraceptive use across homeland areas diminished with the addition of community controls for development and migration. Controlling for unobserved heterogeneity indicated that localized conditions could offset the advantages or disadvantages of living in a former homeland.

58 citations